Somerville Hospital to close ICU, reduce staff

Friday

There are changes coming to Somerville Hospital, but if you don’t work there, the hope is you won’t see them.

There are changes coming to Somerville Hospital, but if you don’t work there, the hope is you won’t see them.

“The service from the point of view of the community should not change and will not change,” said Assaad Sayah, chief of emergency medicine at Cambridge Health Alliance, the parent of Somerville Hospital.

But the changes are coming, and they’re in part due to the way we use that hospital and how medicine is paid for.

- Somerville Hospital’s intensive care will be moved to Cambridge, replaced by a “step-down unit” for less acute cases.

- Surgeries that must happen after usual business hours (7:30 a.m. - 4:30 p.m.) will be performed at Cambridge. The last off-hour surgery will be May 15.

This is all part of a long-term plan to keep Somerville Hospital going in Somerville.

“CHA is continuing to commit to provide to the community in terms of health care services,” said Allison Bayer, senior vice president for operations and chief operating officer of Cambridge Health Alliance. “We’re doing whatever we have to do to be here in the long term.”

The most painful part of the process, Bayer said, was the anticipated reduction in staff. Forty-one full-time-equivalent positions will be lost in the process. Of those, 32 come from the loss of the transitional care unit.

Somerville Hospital was founded in 1891, spurred into being after an editorial supporting it appeared in the Somerville Journal. In 1996 the private, nonprofit Somerville Hospital merged with city-owned Cambridge Hospital, and Cambridge Health Alliance was born. The third hospital, Whidden Memorial of Everett, joined the group in 2001.

The combining of three hospitals into one entity has created some redundancies as well as opportunities, which have lead to changes over the years. A birthing center in Cambridge attracts patients to that site, and the gastro-intestinal department recently enlarged in Somerville sees referral to that campus from many other locations – 66 percent of its patients are referred in from Somerville.

Earlier this year when it was rumored the Cambridge Health Alliance was losing money, questions began surfacing, Ward 1 Alderman Bill Roche said.

“It’s no secret, the Cambridge Health Alliance had to do some cutting back,” Roche said.

“There are a lot of rumors out there about the operating table closing at Somerville Hospital,” Alderman at Large Dennis Sullivan said.

Ward 7 Alderman Bob Trane said the Somerville Hospital was invaluable to the city’s residents who can’t afford expensive care at larger teaching hospitals like Massachusetts General, or those without health insurance.

“It’s very important to keep [the hospital] in the city,” he said.

According to Bayer, that’s what these changes do.

Current regulations require a back-up team of nurses and anesthesiologists be on-call for any surgery. That means if a patient with a bursting appendix comes into Somerville for immediate care, staff can be called in from home to prepare the room for surgery.

According to studies completed at CHA, in some cases, when the patient is taken by ambulance to Cambridge Hospital, “it is equal or even shorter time today, even when we have an OR [open] here in Somerville,” Sayah said. Instead of waiting for staff to come from home, Somerville Hospital sometimes does put the patient, once stabilized, in an ambulance to Cambridge instead of in an elevator, and it is sometimes faster that way. “So actually, the service is not truly changing from a patient’s point of view,” Sayah said.

By not having a team on call that comes in maybe once a week, by Bayer’s estimation, the hospitals save half a million dollars.

The savings is greater when it comes to the Transitional Care Unit.

Patients like those getting hip replacements need not just recovery time but therapy before going home. In Somerville, they have been able to recover for a 10-14 day period at the Somerville Hospital campus, which was easy on some family members – it’s right on the 88 bus line and has fairly ample parking. But that unit is closing.

The good news? That saves about $3.3 million.

The bad news? That sends Somerville patients recovering from surgery to Cambridge, Belmont, Arlington and Medford.

Medicare and Medicaid rules drastically changed how hospitals are paid for transitional care. Three years ago there were two dozen hospital-based TCUs in Massachusetts. There are now 12 left.

CHA has already closed the TCU at Whidden Hospital. That’s sending patients outside the system, but CHA has a plan for that, Bayer said.

“We can get a place that works for you and has a contract with your insurance company,” she said. Plans for care usually start at the time the patient is admitted, working with either social agencies serving the neediest of patients, or just making it easier on those patients with family members visiting. “This ensures patients who need these services can get them, and we are not shutting the door on that,” she said.

The changes at the ICU will not be as great. According to Bayer, after a detailed study of patient needs, it was found the most acute cases were already being sent to Cambridge Hospital or other area facilities. Those in Somerville were just not as sick and didn’t need the same level of care – their needs were indeed a step down from what was going on in Cambridge.

Neither Cambridge nor Somerville hospitals are trauma centers. If someone has a heart attack or has a serious fall, the emergency techs working for Cataldo follow specific instructions on where to take the injured person – and that’s still going to be Somerville Hospital in most cases.

But when your wife is having a heart attack, none of these internal changes should matter, CHA officials said. The guy in the ambulance backs them up.

Dennis Cataldo, vice president of Somerville’s designated ambulance company, said those changes won’t mean any operations changes for Cataldo Ambulance. He’s had detailed talks with the ER doctors at Cambridge Health Alliance, but the kind of care you get won’t change.

“We would bring emergency patients to Somerville hospital following those changes,” Cataldo said.

“The Emergency Department continues to be staffed with highly qualified personnel,” Sayah said. “The percent of emergency physicians [who are] board certified is higher than most of Massachusetts and most of the country.”

And if there is a severe trauma – a serious car crash, a person with multiple gunshots – Cataldo takes that patient right to Mass General or one of the handful of major hospitals that are less than 20 minutes away. And that’s not because the care is less in Somerville, Sayah is careful to say. That’s because those trauma centers have the backup of a thoracic surgeon. Or a cardiac catheter.

“CHA is a very solid, very well respected institution,” Cataldo said. He’d have his own ambulance take him there if he needed it.

Alderman at Large Bill White said he wanted to bring a doctor and administrators from CHA to an upcoming Public Health and Public Safety meeting to be held at the VNA on Lowell Street, so the public could hear what the hospital had to say. “I expect to schedule that in the near future,” White said.

A meeting time and location has not yet been confirmed, but patients having questions about care at Somerville Hospital may call Alison Harris, Director, Media Relations, at 617-499-8323

S.H. Bagley contributed to this article.

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